MLC bargained deal
Effective July 1, 2019, all newly hired employees at CUNY will be covered for health insurance by the HIP HMO Preferred Plan for the first 365 days of employment. After the first 365 days of employment, eligible employees will be able to stay with HIP HMO or choose another health insurance provider from among the providers available to current employees.
This constraint on newly hired employees’ health insurance choices affects all new employees covered by the NYC Health Benefits Program, not only CUNY employees, and was part of the Health Savings Agreement negotiated by the Municipal Labor Committee (MLC – the coalition of more than 90 municipal unions) with the City of New York in June 2018. The savings generated by that agreement set the stage for New York City to settle agreements for wage increases with a number of municipal unions, most notably DC 37 and UFT. The savings also impact what the City of New York is willing to contribute to a contract settlement for PSC with CUNY.
“PSC is not happy that new employees will not have a choice of health insurance providers when they start working at CUNY,” said PSC President Barbara Bowen, who also serves as a vice president of the MLC, “but the City of New York was not willing to discuss wage increases with municipal unions until they had an agreement on additional health savings over the next three years, and this change is a major element of that agreement.”
OPTING OUT
Newly hired employees will be able to “opt out” of the mandatory coverage under the HIP HMO Preferred Plan if they live outside HIP’s service area and cannot access primary care with one of HIP’s HMO providers or if the new employee or eligible dependent is being treated by a non-network provider for a life-threatening or disabling disease or condition. Opt Out Request Forms will be available on the NYC Employee Benefits Program website, the HIP HMO website or from the college Benefits Office.
CUNY has also stated that University Benefits will monitor adjunct health insurance eligibility so that adjuncts’ current coverage will continue and so that newly “eligible” adjuncts (who have worked for two semesters at CUNY) will not be treated as newly “hired” for the purpose of constrained provider choice.
For its part, the HIP HMO Preferred Plan has improved its standard of care for participants, including significant improvements to customer service. “Our commitment to the city and its unions is to deliver the highest-quality care for the hardworking men and women of New York,” EmblemHealth President and CEO Karen Ignagni said in a press release announcing the plan. HIP HMO is a subsidiary of EmblemHealth.
Members in the new HIP HMO plan (also called the “Gold Standard”) will pay $0 copays if they go to a preferred doctor within the plan’s Prime Network of more than 100,000 doctors across the tri-state area, including if they are referred to a specialist within the network by the preferred doctor. With non-preferred primary-care doctors in the network, members will pay a $10 copay for most services, including seeing a specialist in the network. Since the plan is an HMO, a visit outside the network is not covered unless it is an emergency.
When plan participants call the HIP HMO Gold Line they will speak directly with a live person rather than going through a maze of telephone prompts. To date, participants have expressed satisfaction with this improvement. Other aspects of HIP’s commitment to supporting improved health outcomes for participants include voluntary personalized coaching with one-on-one goal setting at no charge, and guided advice concerning fitness, nutrition and stress management. Participants with chronic conditions, including asthma, diabetes and heart disease, will be able to work with a health professional on managing these conditions. Incentives will be offered to encourage participants to get flu shots and age-appropriate checkups and generally maintain a healthy lifestyle.
BENEFITS AHEAD
EmblemHealth is working with two Centers of Excellence – Memorial Sloan Kettering Cancer Center for oncology and Hospital for Special Surgery for orthopedics and musculoskeletal issues – to offer certain procedures at no cost to plan participants starting in the coming years.
“With the improvements HIP is making in its HMO, newly hired employees may find that this health plan meets their and their family’s needs and choose to remain enrolled after 365 days,” said Bowen. “If not, they will be able to enroll in another health insurance plan under the NYC Employee Benefits Program.”
For more information about the HIP HMO Gold Standard Preferred Plan, go to emblemhealth.com or call 1-800-447-6929.
